Nonmyeloablative stem cell transplantation for lymphoma

Semin Oncol. 2004 Feb;31(1):22-6. doi: 10.1053/j.seminoncol.2003.10.017.

Abstract

High-dose chemotherapy and allogeneic stem cell transplantation is a potentially curative therapy for younger patients with non-Hodgkin's lymphoma (NHL). The benefits of this therapy, however, are largely offset by the high rate of treatment-related mortality, exceeding 40% in many studies. Risks increase with comorbidities, advanced age, histocompatibility, and disease-related prognostic factors. Given the potential efficacy of graft-versus-malignancy effects against many lymphoid malignancies, we evaluated an alternative strategy utilizing less toxic, nonmyeloablative conditioning regimens to allow engraftment of donor cells, and then exploit the graft-versus-lymphoma (GVL) effects of allogeneic transplantation as the primary therapy. This strategy involved fludarabine-based preparative regimens +/- high-dose rituximab, graft-versus-host disease (GVHD) prophylaxis for 6 months, and donor lymphocyte infusion (DLI) only for progressive or nonresponding disease. Results from these trials confirm the full potential on nonmyeloablative transplantation for patients with NHL.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide / administration & dosage
  • Drug Administration Schedule
  • Graft vs Host Disease / prevention & control
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Lymphoma / mortality
  • Lymphoma / therapy*
  • Middle Aged
  • Recurrence
  • Rituximab
  • Stem Cell Transplantation / methods*
  • Survival Rate
  • Transplantation Conditioning / methods*
  • Vidarabine / analogs & derivatives*
  • Vidarabine / therapeutic use*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Immunosuppressive Agents
  • Rituximab
  • Cyclophosphamide
  • Vidarabine
  • fludarabine